Healthcare Provider Details

I. General information

NPI: 1881517274
Provider Name (Legal Business Name): NIKOLAI ANDREEV DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

838 N WEST KNOLL DR
WEST HOLLYWOOD CA
90069-4740
US

IV. Provider business mailing address

838 N WEST KNOLL DR APT 325
WEST HOLLYWOOD CA
90069-4730
US

V. Phone/Fax

Practice location:
  • Phone: 323-828-6286
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number113682
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: